Healthcare Provider Details

I. General information

NPI: 1316543473
Provider Name (Legal Business Name): ETHAN MICHEAL PLATT AUD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2020
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5055 A ST STE 300
LINCOLN NE
68510-4970
US

IV. Provider business mailing address

5055 A ST STE 300
LINCOLN NE
68510-4970
US

V. Phone/Fax

Practice location:
  • Phone: 402-488-5079
  • Fax: 402-488-8876
Mailing address:
  • Phone: 402-488-5079
  • Fax: 402-488-8876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2020040100
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2402
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number1827
License Number StateKS
# 4
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number454
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: